Type 2 diabetes, the most common form of diabetes, is a chronic, progressive metabolic disease. It is characterized by chronic hyperglycemia, i.e. an abnormally high concentration of sugar in the blood, and intolerance to carbohydrates. The main cause of this chronic hyperglycemic state is resistance to insulin and inadequate insulin secretion in response to a given metabolic state, but other factors may be involved, as described in Ismail-Beigi F N Engl J Med 2012; 366:1319-27. The main approaches for combating type 2 diabetes should be to reduce the levels of glycemia, to lower the glycated hemoglobin (HbA1c) to a level of less than or equal to 6.5%, and to improve the sensitivity to insulin.
The treatment of type 2 diabetes consists firstly of a change in lifestyle or hygieno-dietetic measures (HDM: the diet, smoking, physical and sports activities). If the HDMs are insufficient, then use should be made of antidiabetic therapeutic agents, generally metformin. However, metformin has many medical contraindications, such as chronic renal insufficiency, acidosis, hypoxia, dehydration, etc. There is thus a substantial paradox for metformin since its prescription is not possible in the case of type 2 diabetic patients presenting with renal insufficiency, but renal insufficiency is one of the common consequences of type 2 diabetes. Other therapeutic agents have been developed, such as dipeptidyl peptidase-IV (DPP-IV) inhibitors, glucagon-like peptide-1 (GLP-1) analogs, thiazolidinediones (TZDs), sulfonylures, glycosidase inhibitors (acarbose, miglitol, voglibose), or sodium glucose co-transporter-2 (SGLT2) inhibitors. However, the correct therapeutic combination is complex since it requires a large number of factors to be taken into consideration, such as the contraindications and the adverse effects, which affect the quality of life of the patients and thus their adherence to the medical treatment. Furthermore, certain therapeutic combinations increase the all-cause mortality, such as the combination of metformin with sulfonylures, as described in Prescrire Int 2015; 24:130-5.
Since HDMs are very rarely adhered to by patients, it is necessary very rapidly to establish a therapeutic treatment with all the adverse effects and contraindications associated with these molecules, and there is at the present time no solution adapted to the care management of type 2 diabetic patients between the HDMs and the establishment of a therapeutic treatment.
Moreover, type 2 diabetic patients have a high risk of cardiovascular morbi-mortality. It is thus also necessary to include in the care management the conventional cardiovascular risk factors especially such as control of the circulating fats, the weight and the arterial pressure. This necessity currently entails the taking of several medicaments of different therapeutic classes simultaneously. However, the combination of drugs may occasionally give rise to serious side reactions, for instance the simultaneous administration of fibrates and statins which increases the risk of myopathy, as described in Denke M A J Manag Care Pharm 2003; 9:17-9.
There is thus a real need for products that can be used both during the attenuated establishment of cardio-metabolic pathologies, characterized by an increase in certain risk factors (carbohydrate disorders, fat disorders, excess weight, inflammation, oxidative stress, arterial hypertension), and during the outbreak of these pathologies, especially type 2 diabetes.
Moreover, there is an urgent need for preventive solutions and medicaments whose “multi-target” mechanism of action has advantages in terms of compliance, tolerance and efficacy. Such products would make it possible to reduce the overall risk of cardio-metabolic diseases and to prevent and treat each dysfunction and/or its consequences taken independently.